Provider Demographics
NPI:1144408337
Name:FORD, DARRELL KEITH
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:KEITH
Last Name:FORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-5456
Mailing Address - Country:US
Mailing Address - Phone:225-201-8901
Mailing Address - Fax:832-550-2140
Practice Address - Street 1:3346 DRUSILLA LN STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1878
Practice Address - Country:US
Practice Address - Phone:225-936-3598
Practice Address - Fax:832-550-2140
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies